The applicant's long-term career goal is to improve the quality of care for chronic skin conditions. In the last five years, supported by a mentored Clinical Investigator (K08) Award, she has developed a quality-of-life outcomes measure for skin diseases, called Skindex. Her immediate career goal is to compare outcomes of treatments for nonmelanoma skin cancer (NMSC). Her research career development plan centers on a longitudinal cohort study of patients with NMSC. With the proposed support she will acquire enhanced skills by focusing on new research questions in this study sample. ENVIRONMENT. This proposal will be conducted at University of California at San Francisco (UCSF) and its affiliate, the San Francisco Veterans Affairs Medical Center (VAMC). The research will be conducted in the VAMC Survey Research Unit, a laboratory for survey research, chart review, and data management. To address incremental research questions, the applicant will collaborate with UCSF faculty in the Institute for Health and Aging and the Departments of Medicine and Epidemiology and Biostatistics. RESEARCH PROJECT. This proposal focuses on a prospective longitudinal observational study of a cohort of patients newly-diagnosed with NMSC at a private practice and a VAMC dermatology clinic. The goal is to compare treatment outcomes among patients treated in different ways. Principal sources of data are patient survey and medical record review. The primary outcome is skin-related quality of life measured by Skindex; additional analyses will compare tumor recurrence, patient satisfaction, and resource utilization among the treatment groups. The applicant will also learn additional analytic techniques to measure patterns of change in quality of life over time, and will address a new research question about how patients' a priori expectations for care relate to process and outcomes of that care. The proposal is significant because of the prevalence of NMSC and the importance of determining its optimal therapy. In addition, this proposal will provide an intensive novel research focus for the applicant. This opportunity will expand her ability to make a significant contribution to the science of health care quality improvement by determining how patients' expectations for care relate to the process and outcomes of their care, thus broadening conventional conceptualizations of health care quality.